Living with heart failure: Effective self-care is key to coping well

The Bottom Line

  • Heart failure, a condition in which a weak heart is unable to pump blood to all parts of the body, can be managed with a healthy diet, regular exercise and other lifestyle behaviours.
  • Even after being told what they need to do to, many people with heart failure find it difficult to make the lifestyle changes that promote heart health.
  • Working with a health care provider to create a personalized and customized self-care program with specific instructions is the most effective approach for people with heart failure.

Any time a medical condition includes the word “failure” it’s a safe bet it’s something serious. So when people find out they have heart failure their reaction is often shock, followed by fear.

Heart failure occurs when the heart becomes weak and is unable to pump enough blood to the rest of the body (1). The weakness may be the result of a previous heart related disease (e.g. a heart attack) or it could be caused by an infection, high blood pressure, toxins such as alcohol and drugs or another medical condition (1). Complications from a weak heart often result in people retaining fluid, which in turn can cause swelling in various parts of the body, as well as coughing, feeling tired and short of breath. Sometimes enough fluid collects in the lungs to cause a life-threatening condition called acute pulmonary edema (2).

So yes, it’s serious. But although there’s no cure, it isn’t hopeless. People can function with the condition; currently an estimated 600,000 Canadians are living with heart failure (2). They can even enjoy a good quality of life by closely managing their medication and caring for themselves with a healthy diet and regular exercise (1).

However, despite the fact that guidelines for heart failure patients includes providing information and self-care instructions (3), many people with heart failure don’t make lifestyle changes that promote heart health (4). Obviously there is a gap between the information patients are given and what they do (5;6). A recent systematic review analyzed the results of 37 studies in an effort to uncover ways of encouraging people to make important lifestyle changes and stick with them for the long term (7).

The studies involved more than 1,300 heart failure patients as well as 75 caregivers to find out their general understanding of heart failure, their knowledge about self-care (including managing medication, diet, physical activity and fluids), as well as their experiences and challenges with self-care.

What the research tells us

The evidence confirms experts’ suspicions: when it comes to heart failure it’s not enough to simply give people information. They may read and have a basic understanding of the steps that need to be taken (e.g. what foods to avoid, which exercises to do, how much liquid to drink) but some people have difficulty knowing how to incorporate the recommendations into their own lives (7).

A personalized, targeted approach may be a solution. For example, healthcare professionals can work with patients to develop a customized self-care plan that acknowledges how their symptoms affect them and suits their needs, abilities and preferences. Related recommendations include seeking patients’ feedback, understanding their personal experiences, offering coaching, and promoting a sense of control (8). Certain psychological strategies that aim to change negative thoughts or increase motivation and resolve conflicting feelings—such as cognitive behavioural therapy or motivational interviewing—can also be useful tools. Evidence shows that these strategies may improve self-care and health-related quality of life, in the short-term, among people with heart failure but no diagnosis of major depression or cognitive impairment (9). The use of ‘decision aids’ (tools that guide people through the process of making difficult decisions) may also be useful in putting together an effective self-care program (8).

The goal is to have patients “take to heart” the messages they receive about their diagnosis and to give them the support they need to take care and take responsibility for their own health.

Learn more about how to manage your heart health

Exercise for people with heart disease: Can health education help change behaviours?

Nurse-led clinics offer support for people with heart disease

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  1. White MF, Kirschner J, Hamilton MA. Self-care guide for the heart failure patient. Circulation. 2014; 129:e293-e294.
  2. Heart and Stroke Foundation. What is heart failure? [Internet] 2015. [cited Apr 2016]. Available from: https://www.heartandstroke.ca/heart/conditions/heart-failure
  3. Arnold J, Liu P, Demers C et al. Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis and management. Can J Cardiol. 2006; 22(1):23-45.
  4. Chaudry SI, Mattera JA, Curtis JP et al. Telemonitoring in patients with heart failure. N Engl J Med. 2010; 363(24):2301-2309.
  5. Clark AM, Freydberg CN, McAlister FA et al. Patient and informal caregivers’ knowledge of heart failure: necessary but insufficient for effective self-care. Eur J Heart Fail. 2009; 11:617-621.
  6. Clark AM, Spaling M, Harkness K et al. Determinants of effective heart failure self-care: a systematic review of patients’ and caregivers’ perceptions. Heart. 2014; 100(9):716-721.
  7. Spaling M, Currie K, Strachan P et al. Improving support for heart failure patients: A systematic review to understand patients’ perspectives on self-care. J Adv Nurs. 2015; 71(11):2478-2489.
  8. Strachan PH, Currie K, Harkness K et al. Context matters in heart failure self-care: A qualitative systematic review. J Card Fail. 2014; 20(6):448-455.
  9. Jiang Y, Shorey S, Seah B. The effectiveness of psychological interventions on self-care, psychological and health outcomes in patients with chronic heart failure-A systematic review and meta-analysis. Int J Nurs Stud. 2018; 78:16-25. doi: 10.1016/j.ijnurstu.2017.08.006. 

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